RESUMO
Basaloid squamous cell carcinoma (BSCC), a variant of squamous cell carcinoma (SCC), is a rare and aggressive epithelial malignancy which has been reported in only 0.1-11 % of primary esophageal carcinomas. In this study, a comparison of clinicopathological features and protein expression between esophageal BSCC (EBSCC) and conventional esophageal SCC (ESCC) cases from Brazil was performed in order to find factors that can be relevant to better characterize EBSCC. The expression of HER2, epidermal growth factor receptor (EGFR), Ki-67, and cyclins (A, B1, and D1) in 111 cases (95 ESCC and 16 EBSCC) was evaluated by immunohistochemistry using tissue microarray. When the clinicopathological data were compared, no significant difference was found between the two histological types. Although the difference is not significant (p = 0.055), the EGFR expression was more frequent in the conventional ESCC than in the EBSCC group. Our results indicate that the clinicopathological profiles of conventional ESCC and EBSCC are similar and provide no indicators for differences in prognosis between these two groups.
Assuntos
Biomarcadores Tumorais , Carcinoma Basocelular/metabolismo , Carcinoma Basocelular/mortalidade , Carcinoma de Células Escamosas/metabolismo , Carcinoma de Células Escamosas/mortalidade , Neoplasias Esofágicas/metabolismo , Neoplasias Esofágicas/mortalidade , Idoso , Biópsia , Carcinoma Basocelular/patologia , Carcinoma Basocelular/terapia , Carcinoma de Células Escamosas/patologia , Carcinoma de Células Escamosas/terapia , Terapia Combinada , Neoplasias Esofágicas/patologia , Neoplasias Esofágicas/terapia , Feminino , Humanos , Imuno-Histoquímica , Masculino , Pessoa de Meia-Idade , Metástase Neoplásica , Estadiamento de Neoplasias , Prognóstico , Fatores de Risco , Análise de Sobrevida , Resultado do TratamentoRESUMO
UNLABELLED: Breast tumors exhibit extensive molecular and clinical heterogeneity. One of the most utilized breast carcinoma classifications is based on its molecular aspects and subdivides breast cancer into five major groups based on the expression of certain genes. In this study, we evaluated which factors are important in determining a prognosis after 5 years of follow-up for patients with clinical stage IIA breast tumors. We took into consideration the different phenotypes (luminal A luminal B HER-2 overexpression, basal and triple-negative), various epithelial-mesenchymal (EMT) molecular markers and adhesion molecules (E-cadherin, P-cadherin, N-cadherin, vimentin, twist snail and slug) and NOS-2, in addition to clinical and demographic data, tumor characteristics and treatment types. METHODS: The study population consisted of 82 patients with breast cancer. We analyzed eight molecular markers by immunohistochemistry on tissue microarrays containing breast tumor specimens from patients with ten years of follow-up, and we classified each tumor according to its estrogen receptor, progesterone receptor and HER-2 expression. We then placed the tumor into one of the above categories. RESULTS: The presence of several clinical and demographic factors, various histopathologies, treatment forms and several immunohistochemical markers were not associated with a worse prognosis for group IIA patients. The factors that were associated with a mortality risk were the triple-negative (odds ratio (OR) = 11.8, 95% confident interval (CI) = 2.0-70.3, P = 0.007) and basal (OR =18.4, 95% CI = 1.8-184.7, P= 0.013) phenotypic patterns. CONCLUSIONS: The EMT markers and NOS-2 were not mortality risk factors. Basal and triple-negative phenotypic patterns were related to a higher mortality risk in patients with stage IIA tumors.
Assuntos
Biomarcadores Tumorais/análise , Neoplasias da Mama/química , Carcinoma Basocelular/química , Receptor ErbB-2/análise , Receptores de Estrogênio/análise , Receptores de Progesterona/análise , Neoplasias da Mama/mortalidade , Neoplasias da Mama/patologia , Carcinoma Basocelular/mortalidade , Carcinoma Basocelular/patologia , Métodos Epidemiológicos , Feminino , Humanos , Pessoa de Meia-Idade , Estadiamento de Neoplasias , Óxido Nítrico Sintase Tipo II/análise , Fenótipo , PrognósticoRESUMO
Breast tumors exhibit extensive molecular and clinical heterogeneity. One of the most utilized breast carcinoma classifications is based on its molecular aspects and subdivides breast cancer into five major groups based on the expression of certain genes. In this study, we evaluated which factors are important in determining a prognosis after 5 years of follow-up for patients with clinical stage IIA breast tumors. We took into consideration the different phenotypes (luminal A luminal B HER-2 overexpression, basal and triple-negative), various epithelial-mesenchymal (EMT) molecular markers and adhesion molecules (E-cadherin, P-cadherin, N-cadherin, vimentin, twist snail and slug) and NOS-2, in addition to clinical and demographic data, tumor characteristics and treatment types. METHODS: The study population consisted of 82 patients with breast cancer. We analyzed eight molecular markers by immunohistochemistry on tissue microarrays containing breast tumor specimens from patients with ten years of follow-up, and we classified each tumor according to its estrogen receptor, progesterone receptor and HER-2 expression. We then placed the tumor into one of the above categories. RESULTS: The presence of several clinical and demographic factors, various histopathologies, treatment forms and several immunohistochemical markers were not associated with a worse prognosis for group IIA patients. The factors that were associated with a mortality risk were the triple-negative (odds ratio (OR) = 11.8, 95 percent confident interval (CI) = 2.0-70.3, P = 0.007) and basal (OR =18.4, 95 percent CI = 1.8-184.7, P= 0.013) phenotypic patterns. CONCLUSIONS: The EMT markers and NOS-2 were not mortality risk factors. Basal and triple-negative phenotypic patterns were related to a higher mortality risk in patients with stage IIA tumors.
Assuntos
Feminino , Humanos , Pessoa de Meia-Idade , Neoplasias da Mama/química , Carcinoma Basocelular/química , /análise , Receptores de Estrogênio/análise , Receptores de Progesterona/análise , Biomarcadores Tumorais/análise , Neoplasias da Mama/mortalidade , Neoplasias da Mama/patologia , Carcinoma Basocelular/mortalidade , Carcinoma Basocelular/patologia , Métodos Epidemiológicos , Estadiamento de Neoplasias , Óxido Nítrico Sintase Tipo II/análise , Fenótipo , PrognósticoRESUMO
Most penile cancers are squamous cell carcinomas, but there are several subtypes with different clinicopathologic, viral, and outcome features. We are presenting 45 cases of a distinctive morphological variant of penile squamous cell carcinoma composed of mixed features of warty and basaloid carcinomas. This tumor was earlier recognized in a recent viral study and showed a high association with human papillomavirus infection. However, clinicopathologic features are not well known. In this multi-institutional study, patients' mean age was 62 years. Most tumors (64%) invaded multiple anatomical compartments, including glans, coronal sulcus, and, especially, inner foreskin mucosa. Tumor size ranged from 2 to 12 cm (mean 5.5 cm). Three morphological patterns were recognized: (1) the most common, observed in two-thirds of the cases was that of a typical condylomatous tumor on surface and basaloid features in deep infiltrative nests; (2) in 15% of the cases, there were non-papillomatous invasive carcinoma nests with mixed basaloid and warty features; and (3) unusually, predominantly papillomatous. Invasion of penile erectile tissues was frequent, either corpus spongiosum or cavernosum (47% each). Tumors limited to lamina propria were rare. Most tumors were of high grade (89%). Vascular and perineural invasion were found in about one-half and one-quarter of cases, respectively. Associated penile intraepithelial neoplasia was identified in 19 cases and mostly showed basaloid, warty-basaloid, or warty features. Inguinal nodal metastases were found in 11/21 patients with groin dissections. Invasion of corpora cavernosa, high histological grade, and presence of vascular/perineural invasion were more prevalent in metastatic cases. In 21 patients followed, the cancer-specific mortality rate was 33% with a mean survival time of 2.8 years. Warty-basaloid carcinomas are morphologically distinctive human papillomavirus-related penile neoplasms that, such as basaloid carcinomas, are biologically more aggressive than typical warty carcinoma from which they should be distinguished.
Assuntos
Carcinoma in Situ/patologia , Carcinoma Basocelular/patologia , Carcinoma de Células Escamosas/patologia , Condiloma Acuminado/patologia , Neoplasias Penianas/patologia , Lesões Pré-Cancerosas/patologia , Brasil , Carcinoma in Situ/mortalidade , Carcinoma in Situ/virologia , Carcinoma Basocelular/mortalidade , Carcinoma Basocelular/virologia , Carcinoma de Células Escamosas/mortalidade , Carcinoma de Células Escamosas/virologia , Diferenciação Celular , Condiloma Acuminado/mortalidade , Condiloma Acuminado/virologia , Humanos , Metástase Linfática , Masculino , Pessoa de Meia-Idade , Invasividade Neoplásica , Estadiamento de Neoplasias , Papillomaviridae/patogenicidade , Paraguai , Neoplasias Penianas/mortalidade , Neoplasias Penianas/virologia , Lesões Pré-Cancerosas/mortalidade , Lesões Pré-Cancerosas/virologia , Prognóstico , Estudos Retrospectivos , Texas , Fatores de TempoRESUMO
AIMS AND BACKGROUND: Basal-like breast cancer is a distinct group of tumors with heterogeneous behavior, and not all have a poor prognosis. The present study analyzed the prevalence and prognosis of early basal-like breast cancer. METHODS AND STUDY DESIGN: A total of 112 patients with stage I and II breast cancer were retrospectively analyzed using immunohistochemical stains for estrogen receptor, progesterone receptor, HER2, cytokeratin 5/6 and epidermal growth factor receptor. Basal-like tumors were defined as being estrogen receptor, progesterone receptor and HER2 negative and cytokeratin 5/6 and/or epidermal growth factor receptor positive. RESULTS: Of the 112 cases, respectively 13 (11.6%) were basal-like, 77 (68.8%) luminal A or B, 13 (11.6%) HER2 positive and 9 (8%) undefined. In basal-like tumors, epidermal growth factor receptor and cytokeratin 5/6 expression was positive in 5 patients (38.5%) and 12 patients (92%), respectively. There was no significant correlation between basal-like breast cancer and age (P = 0.207), lymph node status (P = 1.0) or clinical stage (P = 0.53). Among all tested biomarkers, positivity was found in 81 (72.3%) for estrogen receptor, 13 (11.6%) for HER2, 11 (9.8%) for epidermal growth factor receptor and 36 (32.1%) for cytokeratin 5/6. Epidermal growth factor receptor expression was significantly correlated with estrogen receptor-negative (P = 0.01) and HER2-positive (P = 0.02) tumors. During a median follow-up of 81 months, there were 26 (23%) disease relapses and 12 (10.7%) deaths. No significant difference relating to disease-free survival and overall survival was noted between basal-like breast cancer and subtypes luminal A and B, HER2 positive and undefined. CONCLUSIONS: The addition of cytokeratin 5/6 and epidermal growth factor receptor defines a small subgroup of patients with basal-like tumors. In a population with early breast cancer, basal-like tumors did not have a prognosis different from the other subtypes. Neither was there a significant association with clinicopathological features. The high frequency of epidermal growth factor receptor positivity in estrogen receptor-negative and HER2-positive tumors represents a potential target in clinical trials.
Assuntos
Biomarcadores Tumorais/análise , Neoplasias da Mama/química , Neoplasias da Mama/patologia , Carcinoma Basocelular/química , Carcinoma Basocelular/patologia , Carcinoma Ductal de Mama/química , Carcinoma Lobular/química , Neoplasias da Mama/mortalidade , Carcinoma Basocelular/mortalidade , Carcinoma Ductal de Mama/patologia , Carcinoma Lobular/patologia , Receptores ErbB/análise , Feminino , Seguimentos , Humanos , Imuno-Histoquímica , Imunofenotipagem , Hibridização in Situ Fluorescente , Queratina-5/análise , Queratina-6/análise , Pessoa de Meia-Idade , Recidiva Local de Neoplasia/química , Recidiva Local de Neoplasia/patologia , Valor Preditivo dos Testes , Prognóstico , Receptor ErbB-2/análise , Receptores de Estrogênio/análise , Receptores de Progesterona/análise , RecidivaRESUMO
Antecedentes. El cáncer cutáneo no melanoma es una enfermedad curable, cuando en los estadíos tempranos es adecuadamente tratado. Cuando ello no ocurre, puede dejar graves secuelas y hasta ser fatal. Objetivo. Analizar las causas de recurrencia, la extensión que puede alcanzar y la supervivencia que se obtiene tras resecciones oncológicas. Lugar de aplicación. Hospital público de atención terciaria de tumores. Diseño. Retrospectivo. Población. 75 enfermos, 64 de ellos masculinos con una relación 5.8:1. La edad media fue 65.8 (39-91) años. El 92 por ciento se hallaba recidivado a tratamientosprevios. La localización más frecuente fueron los párpados. Método: El tratamiento fue quirúrgico sólo del primario en el 25,3 por ciento, con extensión al cuello en el 20 por ciento, a la base del cráneo en el 20 por ciento y a la órbita en el 65,3 por ciento. Resultados: Fallecieron 7 enfermos por causa específica y 15 por causa ajena a la enfermedad. No se hallaron diferencias significativas entre la evolución de baso y espinocelulares. A los 36 meses 51/75, se hallaban vivos libres de enfermedad. Conclusiones. El único tratamiento con intención curativa fue la cirugía radical seguida de reconstrucción inmediata. El gasto en prevención sigue siendo el más económico para evitar este tipo de tumores (AU)
Assuntos
Masculino , Adulto , Humanos , Feminino , Pessoa de Meia-Idade , Idoso , Neoplasias de Cabeça e Pescoço , Neoplasias Cutâneas/cirurgia , Carcinoma de Células Escamosas/cirurgia , Carcinoma Basocelular/cirurgia , Estudos Retrospectivos , Carcinoma de Células Escamosas/epidemiologia , Carcinoma de Células Escamosas/mortalidade , Carcinoma Basocelular/epidemiologia , Carcinoma Basocelular/mortalidade , Cirurgia de MohsRESUMO
BACKGROUND: The complications associated with anterior craniofacial resections for benign and malignant tumors were reviewed in 104 patients treated between January 1981 and June 1996. METHODS: Information regarding patient characteristics, histologic type, history of prior therapy, extent of the disease, extent of surgical procedure, and type of reconstruction were entered in a microcomputer database. To better understand and stage postoperative complications, we divided them into early (<14 days) and late (>14 days) according to the time of presentation, into major and minor depending on the morbidity potential of complication, and into local and systemic ones. Comparison between risk factors associated with complications was made using chi-square analysis with Yates' correction for continuity. Survival analysis was performed using the Kaplan-Meier product limit method. RESULTS: There were 8 (7.6%) postoperative deaths, with only 1 occurring from systemic complications. Complications occurred in 53 (48.6%) patients. Local major complications occurred in 49 (45%) patients, local minor in 29 (26.6%), and systemic in 11 (10%). Early complications occurred in 40 (38.5%) patients and late complications in 13 (12.5%) patients. These complications developed during a period ranging from 1 day to 5 months. More than one complication occurred in a number of patients. Bacterial contamination leading to local septic complications was the principal cause of morbidity, accounting for 54.7% (29/53) of complications. Major complications included meningitis in 8 patients associated with cerebrospinal fluid leak in 7, cerebral abscess in 2, sepsis in 1, and subdural hemorrhage in 1, all of which resulted in death except for one case. The extent of the craniofacial resection (p = .011) was the most important factor associated with major complications. Invasion of the dura and the type of reconstruction of the anterior skull base were the most important factors related to cerebrospinal fluid leakage (p = .048 and p = .032) and meningitis (p = .011). CONCLUSION: Contemporary surgical approaches and methods of reconstruction have enabled skull base surgeons to extend their cranial base resections and increase the 5-year survival rates of patients. Nevertheless, significant complications persist. Knowledge and high index of suspicion together with early recognition of these complications are essential for effective management of patients undergoing craniofacial resection. The factors related to major complications found in this study stressed the need to develop more effective methods to prevent contamination of intracranial structures.
Assuntos
Carcinoma Basocelular/cirurgia , Carcinoma de Células Escamosas/cirurgia , Neoplasias de Cabeça e Pescoço/cirurgia , Complicações Pós-Operatórias , Neoplasias Cranianas/cirurgia , Adolescente , Adulto , Idoso , Carcinoma Basocelular/mortalidade , Carcinoma de Células Escamosas/mortalidade , Feminino , Neoplasias de Cabeça e Pescoço/mortalidade , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Neoplasias Cranianas/mortalidade , Análise de SobrevidaRESUMO
BACKGROUND: Carcinomas of the external auditory canal are rare neoplasms (< 1% of all head and neck malignant neoplasms). OBJECTIVE: To evaluate the prognostic factors in 79 patients treated in a single institution. PATIENTS AND METHODS: The disease was staged as follows: 34 patients with stage T1 to T2 tumors; 43 patients with stage T3 to T4 tumors; 2 patients with stage TX tumors; 68 patients with stage N0 tumors; and 11 patients with stage N1 tumors. The initial treatment was surgery in 59 patients and radiotherapy in 9 patients. Eleven patients were not considered candidates for treatment. RESULTS: To date, 29 patients have experienced local recurrences and 2, neck metastases. The 5-year survival rates were 65% for patients who underwent surgery, 29% for patients who underwent radiotherapy, and 63% for patients who underwent a combination of surgery and radiotherapy. Univariate survival analysis showed statistical difference according to tumor type (P = .003), bone involvement (P = .002), and tumor stage (P < .001). CONCLUSION: Every effort must be undertaken to make an early diagnosis and perform radical surgical resection of squamous cell carcinomas in the external auditory canal. This study validates the staging system used for squamous cell carcinoma of the ear treated with surgery.
Assuntos
Carcinoma Basocelular/patologia , Carcinoma de Células Escamosas/patologia , Meato Acústico Externo , Neoplasias da Orelha/patologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Brasil/epidemiologia , Carcinoma Basocelular/mortalidade , Carcinoma Basocelular/radioterapia , Carcinoma Basocelular/cirurgia , Carcinoma de Células Escamosas/mortalidade , Carcinoma de Células Escamosas/radioterapia , Carcinoma de Células Escamosas/cirurgia , Terapia Combinada , Neoplasias da Orelha/mortalidade , Neoplasias da Orelha/radioterapia , Neoplasias da Orelha/cirurgia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Recidiva Local de Neoplasia/epidemiologia , Estadiamento de Neoplasias , Prognóstico , Taxa de Sobrevida , Fatores de TempoRESUMO
BACKGROUND: We retrospectively reviewed the medical charts of 57 patients with advanced malignant cutaneous tumors involving the anterior skull base who underwent combined craniofacial resection in our department from January 1, 1981, to December 31, 1994. METHODS: The data regarding histological results, demographic aspects, clinical presentation, previous treatment, extent of the disease, extent of surgical procedure, type of reconstruction, complications, and follow-up were analyzed using the chi 2 method. Survival analysis was performed using the Kaplan-Meier method. RESULTS: We found prevalence of the male sex (60%) and white race (86%), with a mean age of 62 years. Thirty-five patients (61%) showed extensive lesions directly invading the anterior skull base (type II); 46 patients (81%) had been treated previously; 10 patients (18%) had dural invasion; 29 patients (51%) could not have the eyeball preserved; 32 patients (56%) underwent microsurgical reconstruction; and 45 patients (79%) underwent pericranial or galeal-pericranial flap reconstruction for the anterior skull base defect. Postoperative complications occurred in 29 patients (51%). The most common complication was postoperative infection (17 patients [59%]). Thirty-two patients (56%) were free of disease, and 4 (7%) were alive with disease at the time of our study. CONCLUSIONS: The extent of facial disease (P = .005) and the type of facial reconstruction (P = .01) were the most important risk factors in the development of infectious complications. Invasion of the dura and the type of reconstruction of the anterior skull base were the most important factors related to cerebrospinal fluid leakage (P = .003) and meningoencephalitis (P = .06). Invasion of the dura mater significantly affected survival (P = .005).